DATE: April, 1991
EDITION: Volume V, Number 1
David Trimble, Editor
Jodie Kliman, Associate Editor
CONTENTS
-In July, 1990, I got a note from Liz Hemley at Mount Tom Institute for Human Services, telling me that the new Executive Director, a family therapist and "(so far) confidence-inspiring administrator", was very supportive of network therapy. Since then, Mount Tom has had to confront some internal fiscal problems, in addition to coping with the general downturn in the Massachusetts economy and increasing public distrust and disinvestment in government human services (Massachusetts voters just elected a governor who is accelerating the pace of drastic cuts in state services initiated by his predecessor.). I spoke with Larry Ruhf of Mount Tom in January. He told me that both Kathryn Kaminsky and Liz Hemley were laid off, effectively ending the life of the Mount Tom network therapy team. Despite this very sad news, Larry remains enthusiastic about the value and efficacy of network therapy, and looks forward to the day when it establishes its proper place in mental health practice in the United States.
-Anne Coppard has had to leave her position as Coordinator of the Social Network Program at COTA. Readers who would like to get in contact with her should make note of her home address and telephone in the NETLETTER News section below.
The COTA Social Network Therapy Program is still going strong under the direction of Claudia Blumberger. They are maintaining a complement of six part-time "SNT therapists," four social workers and two occupational therapists, working with networks in the metropolitan Toronto area. The government has expanded their mandate beyond the chronically mentally ill to include the elderly (particularly the networks of Alzheimer's patients), and adolescents with psychiatric problems. The Program has established a social skills group open to referrals from all COTA staff, and is working to tighten links with hospitals and other referral sources. Claudia tells me that, in addition to the occasional training conferences COTA hosts for other human service professionals, COTA is planning to circulate a social network therapy newsletter among Canadian human service organizations.
-Don Fuchs reports that the Neighborhood Parenting Support Project in Winnipeg, Manitoba, has had its life extended from its original termination date of April 1, 1991, to December 31, 1991. The final report on the Project will be issued in March, 1992. With the additional support, the Project plans to do a "post-test" study of the neighborhoods targeted by the intervention, and to do a follow-up of a particular network intervention. The Provincial government has become substantially more supportive of the network intervention approach to child maltreatment isssues, as public and government dissatisfaction with conventional child protective services continues to mount. Unfortunately, at the agency level, the service model is retrenching from the contextual model, moving more and more in the direction of "policing," with centralized, specialized professional intervention services. This has made collaboration at the neighborhood level, where the Project operates, more difficult.
-Gunnar Forsberg reports that the Stockholm Emergency Network Centre has enlisted three new staff members. Kerstin Marklund is expecting a baby, and Astrid Hultkrantz is headed for a Third World country to work with her husband. Gunnar sent along his translation of some of the report from Botkyrka child abuse prevention research project, which will be reviewed in detail in the next NETLETTER.
-Flushed with our successes at the 1990 Annual Conference of American Orthopsychiatric Association (see CONFERENCE PRESENTATIONS, below), network therapists prepared three proposals for Ortho's 1991 Conference, one from Sweden, one from Mount Tom, and my own repeat of the "Key Ideas," drawing from North America and Norway. None of them was accepted. Ortho in fact is in serious financial crisis, and one of their responses was to cut the size and scope of their Annual Conference. The program was restricted to presentations on the Conference theme; the Conference was cut by a day, and the number of offerings was further cut within these constraints. Network therapists lost not only a forum to present our work, but also the chance for our annual informal gathering to share our experiences and support each other's efforts. COTA had planned to host that informal gathering this year. I will be in correspondence with Ortho to see if there is some way we can revive Ortho's role in gathering us together, but I am not optimistic. I believe that we will need to find some other means to bring network therapists together in the future.
-I recently had another opportunity to participate in an experience which demonstrated the utility of the Mount Tom model of teamwork in a full-scale network assembly. Jodie Kliman got a referral for an assembly in the fall of 1990. The index patient was hospitalized for major depression. For the last twenty years, he had been unemployed, occasionally very active in community political action. He and his wife had raised three children, now adults, while keeping the fact of his depression hidden from a large and extensive family network. Working with the wife and oldest son, Jodie had the family assemble a group of about 50 people, balanced between close and peripheral network members, and including supports for each individual family member. Jodie was the conductor, with Nancy Werk and me serving as team members. We held one assembly; it is possible that we might be called upon to convene another. The meeting appears to have productive; the wife reports that the people who pledged to be actively engaged with the family have for the most part kept their vows, and that the couple has had much more social contact with many more people than before the assembly. It may be difficult to get further followup, as this network appears to have polarized somewhat against the team, and we may not hear further from them. The wife did tell us that her husband became very angry at her while still hospitalized after the assembly, blaming her for exposing the secret of his severe depression.
This assembly was an opportunity for me to observe the phenomenon of the "emotional conductor" which the Mount Tom people have described. Over the course of many assemblies, they found that one member of the team (not always the same team member, and sometimes a different team member for different assemblies of the same network) would become the vehicle for the emotional undercurrents in the assembly. In making decisions, the team would consult with the emotional conductor to get a reading of the emotional state of the group.
In the case of this network assembly, teamwork was complicated by the constraints of the physical space. The crowd was jammed into a large living room, filling the floor and the surrounding walls. There was not really enough room for team members to move around the outside of the group, and no room to pass through the middle without making one's movements the focus of the whole group's attention. Nancy positioned herself behind the group opposite from Jodie the conductor, and I tried to move between them. Most of the time that I squeezed behind people to move around, I wound up pulling out the plug wire for the light for the video camera. We were able to leave the room as a team only once in the course of about three and a half hours of assembly. We found it very hard to get the meeting unstuck after the initial revelation of the family's secrets. The meeting settled into a fairly stereotyped pattern of individuals testifying to their affection, admiration and concern for the husband and other members of the family. As the messenger between the stationary Jodie and Nancy, I found over the course of the evening that Nancy was becoming more and more distressed by the network's evasion of their underlying painful feelings of despair, anger, sorrow, and frustration. From her end of the room, Jodie would try to get people to confront their difficult feelings, and I would get the sense that we were beginning to get somewhere. Checking back in again with Nancy, I would find her more and more frustrated with the group resistance to emotional confrontation. Moving back to Jodie, I would again find myself with Jodie inducted back into the flow of glowing testimonials from this highly educated and eloquent group of people. Finally, I myself began to react with some emotional intensity to Nancy's pain, and we got a breakthrough when I sat directly behind Jodie's ear and softly repeated Nancy's suggestions that people start to talk about what they were feeling. As Jodie followed through, the meeting shifted into depression (the six-stage spiral model) or shared emotional experience (the Mount Tom model), and the index patient became even more connected to the other people in the room. He had started the meeting mute, avoiding eye contact, and posturally folded into himself. He gradually became more responsive, looking up and occasionally shaking the hand of an old friend after a testimonial. After the breakthrough, the transformations became more dramatic, as he began to talk to and to embrace the network members who came up one at a time to "speak from the heart" to the family.
In reflecting on the team experience, I was struck by the intensity of my own distress at Nancy's emotional pain as the "emotional conductor." Nancy reported that it took her a day or two to recover from the experience of bearing all the unexpressed rage and despair in the system. During the assembly, despite my feeling that I had a reasonable clinical understanding of what was going on in the group process, I was pulled between two reactive emotional states. When at Jodie's (the formal conductor's) end of the room, I was inducted into the group resistance, and was caught up in the testimonials. When at Nancy's (the emotional conductor's) end of the room, I was reacting to her manifest emotional pain. Eventually, my empathic reaction to the emotional conductor won out. It was obviously hurting Nancy, as emotional conductor, that people in the room were sitting on such powerful negative feelings, and I acted primarily out of a protective concern for the welfare of my friend and teammate.
Before this assembly, I had had plenty of experience with the importance of the team group process in managing the group process of the assembly. I had understood this team group process in the frame of reference of the spiral model, with the team moving through the stages of the spiral a step or so ahead of the assembly. With this assembly, it was obvious that our team group process, with me as the message bearer between the formal conductor and the "emotional conductor," was crucial to the breakthrough in the assembly. I am grateful for the pioneering work of the Mount Tom team in making this team group process intelligible.
-Lugtig, Don (1990). Neighborhood Parenting Support Project: Summary report of findings of community survey with implications for network intervention. Neighborhood Parenting Support Project, Winnipeg, Manitoba.
This Project document reports on a random sample survey of parents in two inner-city Winnipeg neighborhoods, selected on the basis of high incidence of child maltreatment cases with protective agencies. Of the estimated 600 parents in the two neighborhoods, 120 parents were interviewed. The orienting concepts for the survey were social support, both personal support and support in the parenting role, and the social network patterns of this support. Granted the effects of poverty in inner-city neighborhoods on risk for child abuse, what are the additional aggravating and mitigating factors coming from the parent's relationship context? Don cited the study by Garbarino and Sherman (1980), which found different levels of incidence of child abuse in two urban neighborhoods which were similar in economic levels and population profiles. Compared with parents in the high-risk neighborhood, parents in the low risk neighborhood rated their support for family living higher, reported more neighborhood exchanges, and rated their neighborhood higher as a good place to raise children.
The Project gathered demographic information, information about respondents' perceptions of personal and parenting support and personal networks, measures of life stress (both life crisis events and recent concerns - a measure of day-to-day strains), and psychological distress (the Center for Epidemiologic Studies Depression Scale). To measure risk of child maltreatment, the Project used a scale (Avison, Turner, and Noh, 1980) which had demonstrated validity and reliability in discriminating abusive from nonabusive parents. It was necessary to adapt this instrument to the variety of ethnic minority populations in the neighborhoods, which could raise some problems in interpretation of the findings.
The Project looked at the relationship between risk of child maltreatment and social support/social network factors across their whole sample. They found that parents who showed lower risk of child maltreatment shared the following characteristics, in comparison to high-risk parents: Low-risk parents were more likely to have people to talk to about personal concerns and about accessing formal services (particularly preventive services, e.g., daycare and family/parent child centers). Low-risk parents had larger and more diverse personal support networks and larger parenting support networks. For all parents, the number of personal and parental helpers increased with the number of recent parenting concerns. Risk tended to decline as the number of helpers per problem shifted from fewer than one to more than two. This finding suggests a greater flexibility and resourcefulness in help-seeking by the lower-risk parents. Lower-risk parents tended to define their neighborhoods more broadly in spatial terms. They also saw themselves as having more in common with their neighbors. Low-risk parents were more likely to express satisfaction with particular forms of parenting support from neighbors (i.e., listening, feedback, giving or lending money, clothes, toys, transportation). Other network variables, such as density of the parenting support network, frequency and intensity of contact through the ties, reciprocity, and reliability of support, had not yet been analyzed.
The Project identified two neighborhoods, A and B, which were similar in that the average household income was well below the Canadian poverty line, respondents' psychological distress was more than double the cutoff between depression and nondepression for the use of that scale for the general population, and less than 50% of respondents reported feeling positive about seeking help, or about the help they received. The neighborhoods were different in a number of ways. Neighborhood A had a lower proportion of respondents born outside Canada, and a lower proportion (39%, in contrast to Neighborhood B's 57%) of respondents who identified as aboriginal (The groups U.S. residents generally name "Indian" or "Native American"). Neighborhood A had a lower household income, more single parents, and respondents scored significantly higher on indicators of economic distress, life crisis, recent concerns, and psychological distress than respondents in Neighborhood B. Despite respondents in Neighborhood A having so much more stress, they showed a significantly lower child maltreatment risk level than parents in Neighborhood B.
The Project found that residents of Neighborhood A had a "wider concept of neighborhood and ...broader use of support at a personal level, as well as larger personal and parenting helper network size, and greater use of preventive parent-child services" than residents of Neighborhood B, and "tentatively concluded" that these differences accounted for the lower levels of child maltreatment risk, despite the higher stress level in Neighborhood A.
It's not clear how much of the difference between Neighborhoods A and B can be attributed to the differences in cultural diversity. The Project's dependent variable of risk of child maltreatment was measured with an instrument which had to be adapted to the cultural variability of the population, which raises questions about the reliability of the adapted instrument. Aboriginal respondents in Neighborhood A did score lower on risk than did aboriginal respondents in Neighborhood B, which is consistent with the overall difference between neighborhoods. The Project document, citing in part the concerns of its Community Advisory Committee, warns against making generalizations about these limited data on ethnocultural differences.
The Project made some interesting comparisons between "newcomers" and "oldtimers" in Neighborhoods A and B, both of which showed a high rate of turnover. In Neighborhood A, the residents who had been there longer (a year or more) were better connected with supports, had a larger concept of their neighborhood, and less economic stress than newcomers in Neighborhood A. In Neighborhood B, the newcomers actually had larger conceptions of their neighborhood, and more connections to social supports than the oldtimers in Neighborhood B. These differences imply different intervention strategies. One would want to connect newcomers with oldtimers in Neighborhood A. In Neighborhood B, one would want to link the newcomers together first, then draw in the oldtimers.
Each neighborhood had "pocket" neighborhoods where there were significantly higher levels of risk of child maltreatment. In high-risk pockets in Neighborhood A, there was a high degree of social interaction, whereas in pockets in Neighborhood B, there was "general isolation, lack of identification with neighbors and desired help." These differences suggest two distinct patterns of risk. In the case of Neighborhood A pockets, the picture is consistent with some of the early research on networks and child abuse (e.g., Salzinger, Kaplan, and Artemyeff, 1983), which found tiny, very dense networks with a high degree of interaction, suggesting the operation of a deviant normative reference group permitting and supporting the abuse. In the case of Neighborhood B pockets, the picture is one of a household which is exhausted and unable to muster support, in which the abuse might be understood as the venting of frustration by adults who are depleted and unable to meet the demands of childrearing.
The document concludes with a discussion of network intervention strategies for the two neighborhoods, combining the techniques of consultation, coaching, connecting, convening, and construction. Key resources are the Neighborhood Parenting Support Worker, who conducts outreach, links parents with each other and with neighborhood natural helpers, and facilitates linkages between parents and formal support services, and the Neighborhood Resource Exchange, an apartment in the neighborhood serving as a gathering place for parents to exchange support (which includes informal information- sharing about utilizing formal support services).
The strategy for Neighborhood A is to speed up social integration of newcomers by helping to organize a neighborhood "Welcome Wagon mechanism," outreach by the Parenting Support Worker, and development of the Neighborhood Resource Exchange. The strategy for Neighborhood B is designed to address the high cultural diversity of the neighborhood by working with appropriate federal and provincial departments to establish a "federation organization" linking representatives of different groups to find ways to bring together neighborhood parents "of different backgrounds but with similar personal and parenting concerns."
Many respondents to the survey expressed a high degree of interest in the Project, and readiness to host neighborhood gatherings to discuss the Project and the survey findings. The Project plans to utilize these initiatives from the neighborhoods.
The Project, which began in 1988, was originally scheduled to run through the spring of 1991. Don Fuchs tells me (see NEWS) that the funding has been extended to the end of 1991, with the final report due in March, 1992.
REFERENCES Avison, W., Turner, R.J., and Noh, S.(1986). Screening for problem parenting: Preliminary evidence in promising instrument. Child Abuse and Neglect, 10, 157-170.
Garbarino, J. & Sherman, D.(1980). High-risk neighborhoods and high-risk families: The human ecology of child maltreatment. Child Development, 15, 188-198.
Salzinger, W., Kaplan, S., & Artemyeff, C.(1983). Mothers' personal social networks and child maltreatment. Journal of Abnormal Psychology, 92 ,68-76.
I received the first part of the Project's report on the final quarter of the second year of the Project, which described social network intervention with individual parents. The balance of the report will cover network intervention at the neighborhood informal network and at the neighborhood informal/formal support and service levels. The Neighborhood Parenting Support Worker recorder recorded intervention wiith 54 parents, using 149 distinct intervention activities, defined as "a contact between worker and subject with substantive exchange of content in either their home, an office, other community behavior setting, or on the street. Duration usually from half an hour to one hour or more."
To record the Parenting Support Worker's activity, the Project developed the Interact Information System, designed to track activities, the targets of activities, and the change objectives of the activities. Activities were categorized as consulting, connecting, coaching, convening, and construction. Change objectives were characterized as structural, linkage, content, individual, support for helpers, and connection [of the Parenting Support Worker with others in the community]. This report includes data analysis which examines the association between a particular activity and the frequency of that activity when directed toware a particular Project objective. Given the relatively small number of interventions and the novelty of the Information System, it seems appropriate to regard the data analysis as exploratory; the Project lists its purposes as "gaining a beginning empirical understanding of the intervention, attempting to distinguish whether there are patterns which could inform further interventions, and learning about the shortcomings in the information and tracking system."
The most frequent intervention activities were in the category of consulting. The specific activities are listed as follows in descending order of frequency (f): Identifying central figures (f=50), learning about neighborhood and its support network (f=50), identifying linkage persons (f=40), identifying and mapping networks (f=24), consulting with other professionals (f=18), identifying individual parenting strengths and needs (f=9), consulting residents with other residents (f=3), consulting with ethnic interviewers (f=0). The most common change objective reported for consulting was expanding connections to enlarge networks. The most common combination of activities directed to this objective was identifying central figures, identifying linkage persons, and learning about the neighborhood and its support system; the next most commonly used combination included the above activities with the addition of identifying and mapping networks. Consulting served not only to expand the parents' personal and parenting networks, but also the Neighborhood Parenting Support Worker's network of community ties.
Activities included within the intervention strategy of connecting included the following: supporting discussion (f=11), introducing support need (f=10), introducing or facilitating meeting (f=6), facilitating ongoing meeting (f=4), encouraging individuals to connect with other individuals (f=2), and outreach to community (f=1). The connecting strategy appeared to be used primarily to connect individuals to formal and quasi-formal support systems. The activities of introducing or facilitating meetings, supporting discussions, introducing support needs, and supporting discussion were associated with the structural change objectives of enlarging connections to expand networks, tightening links, and constructing clusters. Linkage changes appeared to result from encouraging individuals to connect with other individuals.
Activities in the category coaching included the following: teaching individuals (f=26), supporting development and understanding of network skills (f=20), social skills training (f=16), outreach skills training (f=3), and teaching a workshop (f=2). There was some overlap between social skills and network skills training. The most common pattern of activities included teaching network concepts, social skills training and support for understanding and developing a person's network. Frequently used with neighborhood natural helpers, this strategy appeared to require more establishment of a relationship between worker and parent.
Convening activities included the following: educational networking (f=8), personal network assembly (f=6), socialization networking (f=4), neighborhood cluster meeting (f=1), meeting with professionals (f=1), meeting between resident and formal helping system (f=1), and community information meeting and community network assembly (f=0). Education networking and personal network assembly were used to work toward cognitive and behavioral feedback, to increase frequency of contact in ties, and to increase reciprocity in ties.
Constructing utilized the strategies described above, particularly for assisting isolated persons. It included the following activities: identifying support needs and possible support providers (f=9), coaching persons on network construction (f=5), connecting persons to network providers (f=3), and providing ongoing suport to a cluster or group (f=0).
This first section of the quarterly report concluded with three case descriptions of intervention with individual households. The illustrations showed the power of the Project's data gathering strategies in describing the households' problems, strengths, and needs, and the characteristics of their networks (including problematic and constructive features). The case descriptions show the flexibility of the Parenting Support Worker's approach, ranging from simple mapping and advising to direct participation in the client's network (e.g., meeting with the client and her son's school staff, acting both as advocate and as social skills coach). The cases described involved the following: using consulting as the primary intervention strategy for a woman struggling with the stresses of marital separation and the birth of a new baby; consulting, connecting, connecting, coaching, and convening for a single parent with a hyperactive 8 year old son; coaching, constructing, and consulting for a single parent who was explicitly afraid of harming her children.
On the basis of these two reports on the progress of their work, it certainly appears that the Project will have a substantial contribution to make in their final summary once the Project has concluded. The Project's work, and the work of the Swedish child abuse prevention team, demonstrate persuasively that a social network intervention approach can be applied productively to the problem of preventing child maltreatment.
-"Working with social networks in crisis: Techniques and demonstrations." (April, 1990). Eva Bergerhed, Gunnar Forsberg, Johan Klefbeck, Kerstin Marklund, and Lawrence Ruhf. Sixty seventh annual meeting, American Orthopsychiatric Association. Miami, Florida.
My apologies to the Moderator(s) of this panel. I have been unable to locate the Conference program, and cannot identify the Moderator(s).From my notes and recollections, the Swedish team and Larry Ruhf worked in the collaborative fashion characteristic of network therapists everywhere. The workshop was attended by about a dozen people. The Swedish team described the Emergency Network Centre (a project which was described in the last NETLETTER), and Larry described the work at Mount Tom Institute for Human Services.
The Network Centre team, describing themselves as a "tribe crossing the ocean to visit the North American tribe," warmed us up with group participation in a Swedish children's rhyme, followed by the "Old MacDonald's Farm" song familiar to North Americans. They then described the Botkyrka district outside Stockholm where their project delivers services to "kids 0 to 20 in crisis." The district grew rapidly in the 1960's and 70's to its current population of 35,000. Thirty percent of the district (and 60% of the project's service area) is immigrant, including primarily Turks, South Americans, and other Scandinavians. The Network Centre addresses the problems of people in crisis whose most important ties are elsewhere. It is well connected to health, mental health, child welfare, and academic institutions in the district and the Stockholm area.
Larry described the nine year old Mount Tom program, originally established as part of efforts by the Department of Mental Health to reduce the population at the regional state mental hospital. His enthusiastic presentation conveyed the pioneering spirit of the team, which developed the three- stage model (convening, connecting by facilitating a shared emotional experience, and returning responsibility to the network) over the course of scores of network assemblies. Addressing the needs of people with very small networks led to the development of smaller scale meetings, which tended to be longer- range interventions, adding people over the course of many meetings as a way of building networks. He told of working with an elderly woman for one meeting a month for two years. The team has applied the network approach to adolescent problems, substance abuse, and AIDS. Larry was quite inspirational in exhorting people to "adapt it to your own work with some training, courage, and boldness.... When all else fails, have a network meeting." He told us that the network model applies to any kind of human service work which involves suffering and difficulty. As a final note, in discussing the use of songs both to illuminate and to facilitate the course of a meeting, he advised his listners to watch out for slow, dreamy songs, such as "Row your boat."
The panelists then recruited the audience into a role play simulation of a network assembly at the Emergency Network Centre. Johann and Larry stood off to the side at the top of a set of stairs conveniently located in the conference room, serving as observers and commentators. Eva, Gunnar, and Kerstin served as the team, working with the problem of Eric, an 11 year old boy who could not sit still in class, and who had recently threatened his teacher with a knife. The presenters took some time first to present the case, giving us insight into the considerations involved in inviting network members and planning strategy for the assembly. Eric's household included his father, a famous former football player, father's third wife Lisa, and Eric's 13 year old brother. Kin included his biological mother and grandparents, and his former stepmother and stepsister from father's second marriage. Professionals included the teacher, the special education teacher, the headmaster, and staff from the child welfare agency and the child guidance clinic. At the start of the intervention, friends and neighbors were unknown to the intervention team. The Network Centre staff emphasized that people who suffer should not come alone; they are burned out. An assembly composed exclusively of sufferers is liable to get caught in a destructive negative spiral. Using the Mount Tom concept of balance, the Centre staff spoke of drawing from three categories, "the suffering, the involved, and the support persons." In composing the invitation list, a guiding principle is that a suffering person cannot choose another sufferer. Particular support persons targeted for this intervention included the school counselor, the director of the child guidance center, father's sister, a friend of the family, and a friend of the biological mother. If a meeting is properly balanced, claimed the Network Centre staff, it will be successful. Thus the invitation process is critical. The process includes preparation of a letter of invitation from the family and the therapist who made the referral for network therapy. Included with the letter is a list of everyone invited. People are urged to invite to the assembly others whom they know are interested.
For the role play, participants assumed the roles of Eric, his father, his brother, his ex- stepmother and her daughter, two child guidance staff and their director, the schoolteacher and headmaster, Eric's biological mother and her friend, and father's father. The team worked with a multi-conductor model, freely sharing the role of directing the meeting. At one dramatic moment, Larry and Johann came down from their observation post to redirect people to their painful emotional reactions. The retribalization was conducted by leading the group through a song embodying three questions and their answers: "Who can sail without the wind; who can row without oars; who can say goodbye without shedding tears? I can sail without the wind; I can row without oars; but never say goodbye to my friend without shedding tears." Gunnar presented the problem situation as father's conflict between fearing the loss of Eric (to foster placement or boarding school) and sacrificing his wife and his other son. The meeting process was marked by lots of angry bitter blaming, with the school attacking Eric and his family, relatives attacking father or Eric himself, and the family turning against the service providers. Despite very vigorous team efforts to change the group's frame of reference, the system moved into a fairly rigid focus on the question of sending Eric off to boarding school. The team had people move to opposite sides of the room to take positions on the question of boarding school; then swiftly redirected people's attention to their feelings of helplessness, sadness, and despair. Sobered and reflective, the network members were then asked to empathize with Eric's own pain about his parents' divorces and separations. With this profound sharing of emotional experience, people dropped their efforts to extrude Eric from the system and one could see the emergence of possibilities to resolve the situation without putting Eric through further traumatic separations.
Participants in the workshop appeared quite enthusiastic about their experience. I was delighted to have the opportunity to watch a talented and experienced team in operation.
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-"Key ideas in network therapy." David Trimble (Moderator), Bibbi Bjelland, Anne Coppard, Ellen Dalland, Donald Fuchs, Kathryn Kaminsky. (April, 1990). Sixty seventh annual meeting, American Orthopsychiatric Association. Miami, Florida.
This panel was designed both as an opportunity to share the progress of current network therapy projects, and to elucidate the key concepts which practicing network therapists find most useful in their work. There were 27 people in the audience, 19 of them "newcomers;" i.e., people who were not already members of the recognized international tribe of network therapists.
Ellen Dalland presented her work at the Tasen psykiatriske langtidspensjonat in Oslo, Norway. A residential facility for young adult borderline patients, it is something of a cross between a collective living experience and a treatment program. Members stay in the community about three years. Most present as extroverted, burdened individuals with lots of guilt and anger; they tend to be unstable, dramatic, and emotional, but not violent or self-destructive. A smaller proportion show tendencies toward withdrawal, with sudden outbursts of aggression. Clients' experiences are dominated by the basic feeling, "I'm alone, unseen, and misunderstood." The program has used network methods , both direct (involving face-to-face contact with network members) and indirect, for a couple of years. Ellen focused on the indirect methods, which make use of mapping for reflection on the client's network experience. Maps are drawn at the outset of a client's stay and at six-month intervals. The "household" sector in these maps is the institutional network. Initial maps are somewhat messy, as client and provider learn how best to represent the social portrait of this "hurt person." Over time, the maps show greater organization as the client develops inner structure. Two categories of initial map are most frequent. In the "frozen map," the network is very small and sparsely interconnected, and experienced as lonely, rigid, and cold, although the client also feels invaded by these relationships. The "invaded map" has many members; it is densely knit with mostly close relationships. This type of network generates strong feelings of invasion in the client.
In reporting on the progress of Community Occupational Therapy Associates in Toronto, Anne Coppard emphasized the importance of operating as guests in the home territory of the client, rather than from a social service agency office. COTA network therapists operate in the clients' homes, and as consultants in "doughnut shops to day care centers" serving the networks of chronic psychiatric patients. They are now drawing from David Turkat's work on enhancing community support, as well as from the research on expressed emotion. Network therapists use strategies of constructing, coaching, and connecting, working to build interconnected sectors or clusters and to increase the size of the network as a whole. Utilizing their early findings about the importance of non-family members and confidantes, the network therapists try to increase the size of the nonfamily sector in particular. They aim for overall stability of the clients' personal networks, and for multiplexity in the relationships. Special attention is given to locating "aggravators" when first mapping the network with the client. One tactic to increase the multiplexity of relationships is direct social skills training for the chronic patients, emphasizing the importance of reciprocity. Coaching in reciprocity necessarily requires working with at least two people, including the patient. The network therapist may work with the patient to assemble a cluster in order to solve practical problems, or to address difficult feelings which may have built up. This work requires familiarity and connection with the resources available in the community. Family education series for network members help to enlarge and knit clusters together, spinning off self-directed social support activity. Anne reported that COTA is now multidisciplinary, with 5 active social network therapists. Don Waszylinski is developing a research report on COTA's work, which also has received notice in the "Graham Report," a government document on building community support in Ontario (More recent COTA developments are cited in NEWS, above).
Don Fuchs reported on the work of the Neighborhood Parenting Support Project in Winnipeg, Manitoba, emphasizing the utility and importance of working with existing natural helpers in the inner-city neighborhoods which are the target of the interventions. He described James Garbarino's model of risk for child abuse, which takes account four factors, i.e., parent resources, childrearing demand (e.g., a handicapped child presents a relatively greater parenting demand), other stressors, and social support. The intervention strategy, or "five C's approach" (consulting, convening, coaching, connecting, and constructing) is based on the assumption that single parents and poor people tend to be more tied into their proximal neighborhood. The Parent Support Worker intervenes at the level of existing neighborhood- wide networks, parent-child centres in the target neighborhoods, parents' groups within these centres, and individual parents at the residential street and block level. Operating as an advocate/mediator for parents with institutional systems, the worker gains access to parents' personal support networks, thereby engaging more and more people to link up through the parenting self-help groups. Don noted their observation of "pockets" of child abuse, small and dense networks with few proximal linkages, and their interventions to open them up with new linkages. Julia Halevy, formerly of the Mount Tom team, was recruited by the Project to convene a network assembly linking mothers and local service agencies, thereby pulling together a new parenting group (See also above, in NEWS and REVIEWS).
Bibbi Bjelland spoke of her work at Larkollen ungdomspsykiatriske behandlingsjem, a residential psychiatric clinic for adolescents, which operates weekdays and is closed for weekends. She spoke of making the personal network of each client a public issue for treatment in the clinic community, a strategy which is possible because of the relatively small size of the clinic. Network intervention consists of maps and meetings, with meetings including group meetings of clients at the clinic, in which they discuss each other's networks in detail. The members of each client's network become real figures to the community through these discussions. At intake, the adolescent and each parent construct a network map separately. The question "whom do you turn to?" guides the inquiry. The interviewer uses circular questioning (e.g., "to whom does your mother turn to when you become demanding?"). Geographical maps supplement the relational maps to further elucidate the social experience of the client. Private sessions to work on clients' "inner life" supplement the clinic group meetings and meetings with clients' nuclear and extended families.
Kathryn Kaminsky of Mount Tom Institute for Human Services in Holyoke, Massachusetts, spoke of the team's search for the core concepts in their work, as the organization around them and the team itself were going through institutional change. No longer formally a separate component, the Mount Tom network therapists were now working with the crisis intervention service and consulting and collaborating with other clinicians. They identified as their core concept the connection of people through shared emotional experience. Connecting people emotionally is what makes a community work, and focusing on this task in interventions helps to restore community where it has been lost or compromised. This key concept proves useful in small network meetings, in teaching, and in staff clinical conferences, where clinicians are asked to invite along supportive colleagues to share their feelings about particularly troublesome cases. Kathryn closed the workshop with a "circle similarity exercise," a very powerful and quite simple intervention which gave us all a strong experience of community. All participants gathered in a circle, then were asked to walk into the center each time we shared a particular experience which Kathryn named. Starting out easy with "all people who live in this area; all people who travelled more than 100 miles, .... all people who crossed an ocean to get here," she brought us gently into more profound experiences, including those who have lost parents or other family members. Returning to this similarity, she asked everyone who had indicated that they had lost a family member, and were willing to share that experience, to sit in a circle of chairs in the middle and to talk about their experience. After some moving accounts from the middle of the circle, people from the outside were invited to talk about how they had been affected by what they had heard. In the space of less than twenty minutes, this exercise generated powerful shared emotional experience, and gave all the participants a genuine experience of community.
-From Clyde Mitchell: Many thanks for your letter. I enclose...my subscription for two years. I have never been active in the health field but am interested, naturally, in the idea of using social networks in health practice. I enclose the Directory listing...I am - or was - primarily a network theorist!
-From Paul Schoenfeld: I believe that a new niche for Network Therapy may be opening up. Managed Care mental health providers (HMO's, PPO's, IPA's) are looking for ways to cut mental health costs, primarily by reducing the amount of psychiatric hospitalization and length of stay. I believe that we might be able to have network therapy integrated into their service delivery systems as a cost effective way of preventing hospitalization and reducing length of stay. For those of you who are interested, think about contacting local HMO and PPO providers [Ed. note: NETLETTER has published a proposal (III, 1, 1988) which could be useful in such promotion.].
I am still struggling to meet the goal of getting two issues out each year. This year looks promising, as I have accumulated more material than I could get into this first issue of 1991. I have more correspondence from readers, my notes on network- and social support-oriented presentations at the American Psychological Association meeting in Boston in the fall of 1990, notes on my review of Carin Roberge's dissertation on divorced single mothers' experiences of their social networks, and I plan to review Gunnar Forsberg's English translation of the 1987 report on work in Botkyrka, Sweden, with children and families at risk, Natverksarbete i multiproblemfamiljer.
Please send me accounts of your work with network therapy. Brief comments and reports can be printed as CORRESPONDENCE; more lengthy pieces either word for word as CONTRIBUTIONS or in summary form as REVIEWS. Your contributions will make the NETLETTER grow; they also motivate me to keep producing it.
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